| Doctor Name: | AUDRA N GILLIS |
| NPI Number: | 1083805451 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | LC50078183 |
| Business Practice Address: | 1701 Enterprise Rd Mitchellville, MD - 207212213 |
| Business Phone Number: | 3014421990 |
| Business Fax Number: | 3016271806 |
| Mailing Address: | 16314 Boswell Pl, UPPER MARLBORO |
| State: | MD |
| Postal Code: | 207723286 |
| Phone Number: | 3014421990 |
| Fax Number: | 3016271806 |
| NPI Enumeration Date: | 08/09/2007 |
| NPI Last Update Date: | 09/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC50078183 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |